Sugar levels all over the place!

[connors mum]

Hi my son has just turned 13 was diagnosed with type 1 july 08 and blood sugars have never been so eratic as they have recently, for the past month they hav been all over the place and we have been doing the 8 point profile to try see whats happening and if hes getting the right amount of insulin but i just dont know were its going for example:

Connor woke on tuesday morning with b/s 22.2 :shock: reduced levemir fom 15 to 10 units took 12 novo had cereal 40g lunch 7.6 took 8 novo 40g carb, dinner 12.7 took10 lev 10 novo had 40g carb as we had chicken + potatoes then bedtime reading was 3.6 3am 2.2 gave lucozade and 2 biscuits came up to 3.8,breakfast 8am 12.2 had cereal 40g carb took 10 lev 10units novo 90mins later 11.9, lunch time 4.7 40g 8 novo 90mins later 5.9 then dinner time 8.8 60g took 10 lev 12 novo 90mins later 2.3 gave lucozade crumpet and jam + biscuit 3am b/s at 19.9 morning 19.7 took 12 novo had 40g cereal 2hrs later 17.6 then come lunch time 3.0 gave lucozade 60g lunch 10 novo 2hrs later 3.1 gave lucozade and cereal bar dinner 13.9 had 50g took 10 lev 10 novo 90mins later 3.0 gave lucozade and pkt crisps for bed came up to 6.7 didnt do 3am check poor soul was shattered and up for school in morning but woke at 14.1 forgot to do his 90mins later but lunch was 7.8 then home at 3pm was 3.9 then dinner was 8.1 so will do another 3am check and start again as its the wk-end. Sorry if iv rabbled on a bit its just im not getting it :?

 

[jopar]

Hi connersmum...

I am confused by your post

I'm reading it has that you reduced levimer (his background/basal insulin) due to being high?
And from the rest of your details you seem to be given the levimer verious times of the day...

Levimer is a long acting insulin, AKA background, basal insulin which is inject to tackle the glucose that comes off the liver to maintain stable glucose when not eating...

It is designed to last 24 hours, injected at the same time every day once a day, some people find though to get a stable basal profile they split the dose into two timed injections (AM & PM) so they can adjust to better..

By what you've written you need to be looking at the levimer and how you are injecting this, and working to stablise his basal..

It is likely that his insulin needs will need adjusting as he grows, also hormone activity as he goes through his teenage years will also effect his control...

 

[ebony321]

Hi,

i can see a pattern here...

Seems to be having hypos just before or after tea time..

do you carb count and adjust insulin for how many carbohydrates he is eating?

The high readings in the morning could be hypo's in the night or having too much carbohydrates when correcting hypo's. I think it would be a good idea to reduce the insulin at lunch time to try stop these afternoon hypo's as he could be bouncing back low during the night... Can't be nice for either of you for all these hypo's!

As he's a teenager he will have hormones running around everywhere which can alter insulin requirements.

You do have some good readings in there too so don't worry too much.

 

[connors mum]

Thanks jopar and ebony

Connor takes levemir in the morning and dinner time sorry i may have typed it at the wrong time but i also think the high reaingd in the morning are due to either hypos through the nite or to much carbs after hypo before bed but im trying so hard to get this right and the readings i typed in were just over the past couple days with the hypos, as the wk before he was constantly high thats why i thought best to reduce levemir i know that his age doent help with the hormones but do they really affect it that much? Thank you for your posts ill keep yous posted how it goes over the wk-end just difficult when hes just wanting to get on with things and im constantly check you b/s hes like :roll: lol thanks agian.

 

[Jen&Khaleb]

I have to agree that your post is a little confusing.

It looks like you normally give 8 units for every 40 gm carb (1:5) but there are times when he is out of range and you give 50 gm carb and do not make an adjustment.

This is a little example for what a fairly good typical day could bring with my son-

6.30am - bsl 7, 7 units Levemir and 1 unit per 15 gm carb
10.00am - bsl 5, 20 gm carb morning tea
12.00pm - bsl 12, 1 unit per 15 gm carb and 1 unit correction (this will reduce Khaleb by 8 mmol)
2.30pm - bsl 4.5, 10 gm carb afternoon tea
5.00pm - bsl 9, 5 units Levemir and 1 unit per 15 gm carb
7.00pm - bsl 6, 20gm carb supper
2.30am - bsl 8

With the information above I can work out that 15 gm carb will raise Khaleb by 8 mmol so that is useful info for hypo treatment.

Knowing what the insulin will do and what carbs do in your child makes life a lot easier. If you are changing the Levemir dose too often you will also find it quite difficult. It takes a few days to settle so it isn't good to change the dose more often than every few days. Ratios can change from time to time and can be very different from one child to the next.

Try to only make small changes in long acting at a time (10-20%). Does your son tell you when he has done heaps of exercise? He might need to have about 10 gm carb before exercise and reduce some insulin at night on those days.

Everyone I know with teenagers says it can be a very difficult time so don't beat yourself up about it. Widen your range a little for a while to try and avoid the hypos. Obviously there are heaps of variables and lots of trial and error.

I still average 1-2 mild hypos and hypers per week as do most parents of children - that's diabetes.

It can be so frustrating when things aren't working out.

Hope you can find some level ground soon to take some pressure off you both.

 

[Angeldust]

I would try splitting the levemir exactly 12 hours apart. Do not reduce long acting insulin due to suagrs being constantly high..this points to requiring an increase.

I agree your post is a little confusing but from what I'm understanding it sounds like you need to increase the levemir and reduce the novorapid. Somewhere in the day the carb to insulin ratio is not consistent and thus causing hypos.

You need to work out how many units of insulin are required for each 10grams carbs. This can also differ at different times of the day. I would maybe start out with 1 until per 10grams and see how that goes, monitor very closely and increase as you feel necessary.

For me I take 1.5 units per 10 grams carbs, this is consistent for me throughout the day, and levemir split 50/50 at 10am and 10pm,

Best of luck

 

[hismom]

hi
before you split the levimar speak to your dsn. my son is 14 and sometimes gets high levels for a week or so before he gets a cold etc. Also the levels of hormones make a big difference. Dont forget being out of the normal routine of school will also affect him as he will be doing different amounts of exercise to normal.


steph

 

[Angeldust]

Yeah sorry I forgot to mention there are many factors that could contribute to levels being whack such as infection or stress. And always consult your dsn before making changes.

 

[hismom]

hi,
I dont know how much help it will be but my sons consultant has told him 60 grams of carbs a meal. My son is 14 so i dont know if that makes any difference.


steph

 

[connors mum]

Hi thank you all for your usefull posts. I phoned the diabetes team and have an appointment to go see them, i know it looks like insulin is non consistant but sometimes iv given more for correction dose and less when connor going to football training or swimming anyway there is a carbohydrate insulin ratio class coming up so i have put us forward for that so hopefully we will get a better understanding of things with that. Connor used to have 60g carbs a meal Steph but were told we could come and go with the amount of carbs when he changed to basal bolus thanks for ur post anyway. i dont know if its just me but i kinda feel like ur just left to get on with it and its an awfull lot to take in i mean iv read the books they give you and stuff but sometimes its hard to understand. anyway thanks agian for your replies they have helped me see things a bit better.

 

[Jen&Khaleb]

I agree that we are left to do it all on our own to some extent. The Doctors, Nurses, Dietician etc... only ever see part of a bigger picture so can't really be making day to day judgement calls on what doses and what to eat. Diabetes needs to fit in with your own home life and that can change fairly frequently, as do kids insulin needs.

Khaleb's medical team really only glance at his day to day figures and want to know if he is having a lot of hypos/hypers. They judge control by his hba1c and will answer or contribute to anything I tell them is going on at home. I try to keep notes on the bottom of Khaleb's records if I have done something out of the ordinary. I often find Khaleb's doctor makes suggestions that just wont work for me and Khaleb. I find it most annoying that between Khaleb's Paediatrician and his Endocrinologist there are a lot of conflicting issues. They should get to know each other a little better but I know they don't have the time.

 

[hismom]

hi,
my son is in theatre so he has days when he is really active the ame as your sons football training. We handle this by changing the doseage on his base insulin. it works well and keeps him fairly even. he still ends up with a kitkat now and then for extr carbs but not often. His levels are good for his hba1c even though he is going through puberty.i must admit we dont stick to the 60 grams of carbs either as it is really restrictive.


steph